German Chanceller Angela Merkel calls for no-fly zone after five hospitals and
two schools bombed in one morning

At least five hospitals including a maternity unit and two schools were hit in a new wave of regime and Russian bombing in Syria on Monday, prompting Angela Merkel, the German chancellor, to become the first major Western leader to call for a no-fly zone to be imposed.

As many as 50 civilians died at the facilities, two of which were supported by UNICEF, the United Nations children's agency. Ban Ki-moon, the UN secretary general, decried the assaults as "blatant violations of international law".

Medecins Sans Frontieres accused Russia of deliberately targeting a hospital it supports in the town of Maarat al-Numan, in Idlib province, with two strikes of two missiles each.

Seven staff and patients including a child were killed in the attack, which levelled the hospital, and eight staff are missing presumed dead, MSF said.

Extraordinary pictures emerged of the bombing of a maternity unit in the town of Azaz near the Turkish border.

Pictures too gruesome to reproduce showed the bodies of children killed in one of the schools, also near Aleppo.

Rescue workers found the remains of a Russian missile near the Azaz hospital, which reported 15 injuries, three serious, among staff.

Adnan Seddik, manager of the Syria Charity, a French NGO which runs the hospital in Azaz, said the facility had been hit by a Russian surface missile at around 8am in the morning, and had only avoided worse casualties because it had evacuated patients to the basement following previous attacks.

"The medical equipment was destroyed, I don't think that we will be able to operate again after three attacks of the hospital," he said.

He accused Russia of a "deliberate bombing", saying the Red Crescent sign was clearly displayed on top of the hospital.

"The goal of targeting hospitals is to force people to displace and send a message, to leave or to be killed," he said.

Aftermath of the alleged Russian air strike (YouTube / Mohamad Kinsh)

Fourteen people were killed nearby in the town, which lies in a shrinking pocket of rebel-held land between the Turkish border and northern Aleppo, surrounded by Islamic State of Iraq and the Levant (Isil) to the east, the regime to the south, and Kurdish forces attacking them from the west.

The United States called on the two powers to lessen tensions, which have been high ever since Turkey shot down a Russian bomber that crossed into its air space.

The attacks came in the wake of a Russian-promoted ceasefire deal announced last week, which was widely mocked among opposition groups. Russia said it was now setting up a “working group” to arrange implementation.

Bashar al-Assad, Syria's president, said on Monday that a ceasefire did not mean each side had to stop using weapons.

"Regarding a ceasefire, a halt to operations, if it happened, it doesn't mean that each party will stop using weapons," Assad said in Damascus in televised comments.

"A ceasefire means in the first place halting the terrorists from strengthening their positions. Movement of weapons, equipment or terrorists, or fortification of positions, will not be allowed," he added.

Turkey has repeatedly called for a no-fly zone to be imposed in Syria to protect civilians, but Western leaders have been nervous about backing the call. It would be opposed by the Assad regime, while Russia has indicated it would veto any attempt to propose one at the UN Security Council.

“The destruction of the hospital leaves around 40,000 people without medical services in an active zone of conflict" pic.twitter.com/5Fg1N0xmPI

But in an interview on Monday Mrs Merkel suggested it might be possible. "In the current situation it would be helpful if there was an area there in which none of the warring parties carry out attacks by air – so a type of no-fly zone," she said.

Hospitals and schools have been targeted throughout the Syrian conflict, sometimes apparently deliberately. Many of the competing militias fighting on the ground have used schools as bases, making them targets, while hospitals are used to treat both military and civilian casualties.

However, an MSF spokesman said there were no military casualties known of from the attack in Maarat al-Numan.

"In the current situation it would be helpful if there was an area there in which none of the warring parties carry out attacks by air – so a type of no-fly zone"

Angela Merkel

“This appears to be a deliberate attack on a health structure, and we condemn this attack in the strongest possible terms,” Massimiliano Rebaudengo, MSF's head of mission, said.

“The destruction of the hospital leaves the local population of around 40,000 people without access to medical services in an active zone of conflict.”

The spokesman said that MSF had paid for the hospital to be rebuilt after it was hit previously in the war.

The regime, which had been on the retreat last summer, has since managed to push forward on several fronts, retaking the half of the province of Latakia it had lost and cutting off rebel-held Aleppo, Syria’s largest city, from the Turkish border to the north.

The rebels are now surrounded north of the city as well, and the Kurdish YPG militia which runs a patch of territory to the north-west has profited from their disarray, driving them back to Azaz, the nearest town to the main border crossing.

That represents the worst possible outcome for Turkey, which has both supported the rebels and fought a long counter-insurgency against the YPG’s allies on its territory, the guerrilla group the PKK.

Mr Davutoglu said he would not allow the Kurds to take Azaz, and Turkish troops shelled YPG positions for the third day running. "We will not allow Azaz to fall," he said.

At one point, the rebel-held patch south of Azaz and the border is just four kilometres across, with Islamic State of Iraq and the Levant holding the area to the east.

If the Kurds close that gap, most of Turkey’s border with Syria will be held by the Kurds or Isil, both sworn enemies.

The regime announced it was launching an attack on Isil’s de facto capital, Raqqa.

Turkey, along with the rebels’ other major backers Saudi Arabia, will be furious if western bombing of Isil allows the regime to retake the eastern half of the country.

Saudi Arabia has said it intends to send jets and special forces to Turkey to join the battle with Isil – and almost certainly seek to ensure it has a voice in the outcome of the conflict.

The Saudi foreign minister, Adel al-Jubeir, said Mr Assad could not be allowed to win. "It is impossible for a man behind the killing of 300,000 innocent people to remain,” he said after meeting Western counterparts in Germany at the weekend.

The United States last night condemned the strikes on the hospitals, but also infuriated Turkey by calling on it to show “restraint” against the Kurds.

America has backed the “moderate rebels” in Syria against the regime and the YPG in its separate fight against Isil, thus finding itself backing both sides in this part of the war. In its support for the YPG, it is on the opposite side from its Nato ally, Turkey.